Healthcare Provider Details

I. General information

NPI: 1346822244
Provider Name (Legal Business Name): EMILY PORTER GERSON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2021
Last Update Date: 04/21/2021
Certification Date: 04/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4910 MASSACHUSETTS AVE NW STE 302
WASHINGTON DC
20016-4388
US

IV. Provider business mailing address

4910 MASSACHUSETTS AVE NW STE 302
WASHINGTON DC
20016-4388
US

V. Phone/Fax

Practice location:
  • Phone: 202-991-9000
  • Fax: 202-793-4900
Mailing address:
  • Phone: 202-991-9000
  • Fax: 202-793-4900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. EMILY PORTER GERSON
Title or Position: OWNER
Credential: MD
Phone: 202-991-9000